Client-Therapist Contract

This document contains important information about my professional services and business policies. Please read it carefully and jot down any questions you might have so that we can discuss them at our next meeting. At our first meeting, I will have you sign a summary of this document. After you have signed, it will represent an agreement between us.


Psychotherapy is not easily described in general statements. It varies depending on the personalities of the therapist and client, and the particular problems that you bring. There are many different methods I may use to deal with the problems that you hope to address. Psychotherapy is not like a medical doctor visit. Instead, it calls for a very active effort on your part. In order for the therapy to be most successful, you will have to work on things we talk about both during our sessions and at home.

Psychotherapy can have benefits and risks. It has been shown to have benefits for people who go through it. It often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. Since therapy often involves discussing unpleasant aspects of your life, you may also experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. But, there are no guarantees of what you will experience.

Our first few sessions will involve an evaluation of your needs. By the end of the evaluation, I will be able to offer you some first impressions of what our work will include and a treatment plan to follow, if you decide to continue with therapy. You should evaluate this information along with your own opinions of whether you feel comfortable working with me. Therapy works best if there is a good fit between the therapist and the client(s). Any time you have questions about my practice, please feel free to bring them up so that we can discuss them. If your doubts persist, I will be happy to help you set up a meeting with another mental health professional for a second opinion.


I normally conduct an evaluation that will last from 2-4 sessions. During this time, we can both decide if I am the best person to provide the services you need in order to meet your treatment goals. If psychotherapy is begun, I will usually schedule one 50-minute session (one appointment hour of 50 minutes duration) per week at a time we agree on. Once an appointment hour is scheduled, you will be expected to pay for it if you cancel UNLESS I have another time to reschedule the appointment during the same week (Monday through Friday). If you are rescheduled within the same week, you will not be billed for the cancelled appointment.


My hourly fee is $150. In addition to weekly appointments, I charge this amount for other professional services you may need. I will break down the hourly cost if I work for periods of less than one hour. Other services include report writing, telephone conversations lasting longer than 10 minutes, attendance at meetings with other professionals you have authorized, preparation of records or treatment summaries, and the time spent performing any other services that you may request of me. If you become involved in legal proceedings that require my participation, you will be expected to pay for my professional time, even if I am called to testify by another party.


You will be expected to pay for each session at the time it is held, unless we agree otherwise. Payment schedules for other professional services will be agreed to when they are requested.

If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, I have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court. If such legal action is necessary, its costs will be included in the claim. In most collection situations, the only information I release regarding a client’s treatment is her/his name, address, any phone numbers where you can be reached, the nature of the services provided, and the amount due.


In order for us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. I am in-network with Aetna. If this is not your insurance provider, I will give you a receipt that you can submit to your insurance company for reimbursement. YOU, not your insurance company, are responsible for full payment of my fees. It is very important that you find out what mental health services your insurance policy covers.

You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, call your plan administrator (Customer Service number usually found on the back of the card.) . Of course, I will provide you with whatever information I can based on my experiences and will be happy to help you in understanding the information you receive from your insurance company. Due to the rising costs of health care, insurance benefits have increasingly become more complex. Because of this complexity, it is sometimes difficult to determine exactly how much mental health coverage is available. “Managed Health Care” plans such as HMOs and PPOs often require authorization before they provide reimbursement for mental health services. These plans are often limited to short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While a lot can be accomplished in short-term therapy, some clients feel that they need more services after insurance benefits end. You should be aware that most insurance companies require you to authorize me to provide them with a clinical diagnosis. If I am not in-network on your insurance panel, I WILL NOT have to provide additional clinical information such as treatment plans or summaries, or copies of the entire record (in rare cases). I have had concerns about this information becoming part of the insurance company’s files and probably being stored in a computer. Though all insurance companies claim to keep such information confidential, I have no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. Once we have all of the information about your insurance coverage, we will discuss what we can expect to accomplish with the benefits that are available.


I am often not immediately available by telephone. While I am usually available between 9AM and 7PM, I will not answer the phone when I am with a client. When I am not available, my telephone is answered by voice mail. I will make every effort to return your call on the same day, with the exception of weekends and holidays. If you are difficult to reach, please inform me of some times when you will be available. If you are unable to reach me and feel that you can’t wait for me to return your call, contact your family physician or the nearest emergency room and ask for the psychologist or psychiatrist on call. If I will be unavailable for an extended time, I will provide you with the name of a colleague to contact, if needed.


The laws and standards of my profession require that I keep treatment records. You are entitled to receive a copy of the records unless I believe that seeing them would be emotionally damaging, in which case, I will be happy to send them to a mental health professional of your choice. Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers. I recommend that you review them in my presence so that we can discuss the content. Clients will be charged an appropriate fee for any time spent in preparing information requests.


If you are under eighteen years of age, please be aware that the law may provide your parents the right to examine your treatment records. It is my policy to request an agreement from parents that they agree to give up access to your records. If they agree, I will provide them only with general information about our work together, unless I feel there is a high risk that you will seriously harm yourself or someone else. In this case, I will notify them of my concerns. I will also provide them with a summary of your treatment when it is complete. Before giving them any information, I will discuss the matter with you, if possible, and do my best to handle any objections you may have with what I am prepared to discuss.


In general, the privacy of all communications between a client and a therapist is protected by law, and I can only release information about our work to others with your written permission. But, there are a few exceptions. 1) In most legal proceedings, you have the right to prevent me from providing any information about your treatment. In some proceedings involving child custody and those in which your emotional condition is an important issue, a judge may order my testimony if s/he determines that the issues demand it. 2) There are some situations in which I am legally obligated to take action to protect others from harm, even if I have to reveal some information about a client’s treatment. For example, if I believe that a child, elderly person, or disabled person is being abused, I must file a report with the appropriate state agency. 3) If I believe that a client is threatening serious bodily harm to another, I may be required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the client. If the client threatens to harm her/himself, I may be obligated to seek hospitalization for her/him or to contact family members or others who can help provide protection. These situations have rarely occurred in my practice. If a similar situation occurs, I will make every effort to fully discuss it with you before taking any action.

Although I share office space with other professionals, each of us operates as our own independent practitioner. No one else has access to your records, phone messages, or other confidential information.

I may occasionally find it helpful to consult other professionals about our work. During a consultation, I make every effort to avoid revealing the identity of my client. The consultant is also legally bound to keep information confidential. If you don’t object, I will not tell you about these consultations unless I feel that it is important to our work together.

While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have at our next meeting. I will be happy to discuss these issues with you if you need specific advice, but formal, legal advice may be needed because the laws governing confidentiality are quite complex, and I am not an attorney.

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